High Incidence of Line-Related Infection and Mechanical Failure of an Antiseptic Impregnated Central Venous Catheter in Highly Immunocompromised Patients

Abstract

Prolonged central venous catheterisation is associated with a substantial risk of line related infection, which may be reduced when a chlorhexidine/silver-sulfadiazine coated catheter (ARROWgard Blue(TM)) is used in medical or surgical ICU patients. However, no data is available from severely immunocompromised patients. We therefore performed an initial exploratory study among patients with haematological malignancy, aplastic anaemia or bone marrow transplantation. The study was terminated after the 12th catheter insertion. Eight of 11 assessable catheters developed a notable degree of mechanical dysfunction, which directly led to catheter removal in 2 patients. Six of the 11 catheters were unstable. Catheter-related infection occurred in 5 instances. Only 1 catheter functioned normally and was unassociated with infection. The ARROWgard Blue(TM) catheter cannot be recommended for prolonged use in these patients.

Antimicrobial chlorhexidine/silver sulfadiazine-coated central venous catheters versus those uncoated in patients undergoing allogeneic stem cell transplantation

“…The incidence of positive blood cultures observed in this study corresponds with previously reported incidence of CVC-related infections and positive blood cultures in hematological patients ranging between 35% and 52% [1,2,4,5,7,13]. A lower number of patients with positive CVC blood cultures in the coated CVC group (45% vs. 36%, p =0.05), more repeatedly positive CVC blood cultures observed in the uncoated CVC group (26% vs. 8,6%, p =0.018), and highly significant difference in positive CVC blood cultures per 1,000 catheter-days (29 vs. 14, p=0.005) showed rather positive effect of the chlorhexidine/silver sulfadiazine-coated CVCs.…”

“…In contrast to the microbiologically documented infections in patients before hematopoietic engraftment of only 5-10%, the focus of bacterial infection can be identified in more than 50% of patients after hematopoietic engraftment [3,11,14]. The incidence of CVC-related infections in hematological patients has been reported to range between 35% and 45% [1,4,5,13] and positive blood cultures have been found in 36-52% [2,7].…”

“…An initial exploratory study by Ellis et al [4] did not recommend impregnated CVCs for prolonged use in severely immunocompromised patients. Ostendorf [9], however, found reduction in risk of catheter colonization, although the incidence of catheterrelated bacteremia was similar to a control group.…”

Staphylococcus aureus Native Valve Infective Endocarditis: Report of 566 Episodes from the International Collaboration on Endocarditis Merged Database

“…By contrast, the proportion of cases of infective endocarditis due to viridans group streptococci or enterococci was significantly lower than that in studies that have encompassed cases from the last 2 decades [26,27]. Our observations on the increasing prevalence of SA-NVIE reflect the probable convergence of 2 important trends: there is an increasing number of patients (e.g., geriatric patients and patients with transvenous pacemakers or indwelling catheters) who are at risk for endocarditis in general, and there is an increasing number of patients (e.g., patients with immunosuppression, diabetic patients, and persons undergoing hemodialysis) who are at risk for S. aureus bacteremia [8,16,[28][29][30]. Given that gram-positive organisms have now overtaken gram-negative pathogens as the most common cause of septicemia in the United States [31], it is likely that rates of SA-NVIE will continue to increase.…”

Chlorhexidine and silver-sulfadiazine coated central venous catheters in haematological patients—a double-blind, randomised, prospective, controlled trial

“…In literature, the incidence of catheter-related infection (CRI) ranges from 5 to 15% [41]. The incidence of CRI in haematologic-oncologic patients was also reported to range from 18 to 45% [11,25]. Infections associated with the use of central venous catheters can result in serious medical complications and expensive care [30].…”